Quality & Performance

Star Ratings, Quality Withholds & Performance-based Contracts

Caremetrics’ Quality Improvement tools are designed to help payers and providers achieve higher scores in Pay-For-Quality programs—resulting in higher revenue earned through quality incentives, bonuses and earn-back of premium withholds.

Where consumer populations are medically-complex, disabled and economically disadvantaged, there is an inherent challenges to achieving accurate quality scores under Pay-For-Quality contracts. Standardized surveys and measurement tools are normative and generally do not adequately adjust for the unique characteristics and communication challenges of complex populations, especially for Medicaid MLTC/MLTSS, SNP and dual eligibles MMP plans.

The beneficial impact of Caremetrics tools is enhanced by our ability to capture clinical content when available, and to get an early-and-often view of potential opportunities for quality and outcome improvement.

Our solutions push actionable interventions to care coordinators, network clinicians, consumers and their families or community caregivers. We prioritize the recommended interventions to achieve highest impact, and measure the overall results to evaluate efficacy.

We prioritize the recommended interventions to achieve highest impact, and measure the overall results to evaluate efficacy.

Caremetrics Quality and Performance tools are specifically designed to enhance performance in the following Pay-For-Quality programs:

Medicare Advantage and SNP five-star quality ratings bonus program

Premium Withholds in Dual Eligible financial alignment demonstrations

Quality bonuses in Medicaid and MLTC/MLTSS contracts

Other performance-based contracts.

Search for:

Recent Updates

MA Duals Demo Opt-out Rate
The Massachusetts demo is the first to go-live in this class. Limited to Consumers aged 21-64, the program showed a significant opt-out rate in the first months since Consumers received their initial enrollment kit and auto-assignment notices. One plan reported that only 4 in 10 Consumers originally assigned to the plan were still enrolled after 90 days. This level of attrition and the lower membership produced will be a key factor in plans' decision to remain in the demo as it is extended past its original 3-year initiation.MORE

Digital Health interventions for Duals
Center for Health Care Strategies confirms the challenges and opportunities that lay ahead for this sector in its December 2013 report on Digital Health Innovations for Medicaid Super-Utilizers:
Consumer Feedback to Steer New Technologies. Worth reading, especially the results of focus groups on this topic, and a great snapshot of case studies from around the U.S. MORE